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Federal_Betrayal  
#1 Posted : Wednesday, August 4, 2021 6:48:55 PM(UTC)

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American servicemen need to ask themselves whether an America that refuses to ease the suffering of those wounded in its defense is truly worth the sacrifice?

At VA and private facilities across the country our veterans are being denied pain medication. It's bad enough that the Government forcibly reduced or rescinded the medication that for months or years has been prescribed civilians afflicted with some of the most severe and intractable pain imaginable (e.g., ankylosing spondylitis, RSD, migraine), significantly gutting their capacity to function and quality of life -- not to mention that of the loved ones who care for or depend on them.

The absurd cruelty is even more pronounced when we refuse compassionate care to our soldiers.

I have the following letter along with a 217 page report to every lawmaker across 25 states as well as every trustee and delegate supporting the AMA and the AARP.

We are now in the throes of a Cold Civil War. Help me and dozens of other patient advocates send the message that this not the America we're fighting to protect. This is a police state where cops and the grieving survivors of dead heroin addicts run health care policy.


Dear Representative INSERT:

It's the cornerstone of a compassionate care system and arguably the signature achievement of a civilization.

And we want to get rid of it.

How often do we catch ourselves muttering "if only there was a pill for THAT?" Well, there IS. It's not only cheap, but it's so uniquely effective that it and it alone is responsible for restoring quality and functionality to the lives of some 11 - 23 million Americans who suffer chronic intractable pain. And it's safe -- long term use of acetaminophen & ibuprofen is toxic to vital organs.

I am referring to opioid based pain medicine -- and to the concerted effort to destroy the lives of any manufacturer, doctor, pharmacist, and patient connected to it. We were told the Prescription Drug Monitoring Database (PDMP) would be used to confidentially collect aggregate statistics on prescriptions. But the PDMP was weaponized into a surveillance and detection tool through which an expanded DEA spy on individual encounters between doctors and patients. Routine PDMP reports flag prescriptions that exceed the CDC arbitrary threshold (for which no basis in science or nature exists) and flag patients with the highest NARX Scores. The physicians who dare treat these patients and dare issue these prescriptions receive phone calls from DEA agents or State medical boards threatening suspension, prosecution, and even incarceration. Hundreds of physicians who treat in good faith have been arrested and thousands more raided and suspended by cops armed with semiautomatic weapons and TV network camera crews.

Civil and human rights -- and the right to individualized, patient-centered care -- has been violated.

And then there was never any need to do it. My Report will convince you of that and vacate preconceptions, foregone conclusions, and anything else you took on faith, authority, or convenience. My Report exploits the best available data, logic, and history -- including a rare social psychological analysis of relevant professionals and organizations -- to build the argument that the so-called "Opioid Crisis" is a byproduct of Federal intervention and mass hysteria similar to the Joe McCarthy-led response to the Red Scare in the 1960s. Whether we're talking about efficacy, toxicity, dependency, teen use, and rank among preventable causes of death, the real facts show that opioids pose no extraordinary threat to public health or national health security. Any problematic pockets or hot spots have already been identified and assuaged with targeted / "surgical" measures (e.g., closure of "pill mills" and education of dentists once-upon-a-time disposed to trade 60 percocet for the wisdom teeth of our most vulnerable youth). As usual our Government does not know when to stop. Even Joe McCarthy's Committee on un-American Activities netted us the Rosenbergs and David Greenglass. After that, we just destroyed the lives and livelihoods of DoD cafeteria workers and Hollywood script writers.

As amusing as it might be to think that we as a nation are more addicted to the "Opioid Crisis" than we ever were to opioids, the impact on chronic pain patients and the doctors who dare treat them is no joke. The Report also includes four illustrative stranger-than-fiction cases of impact to patients that will humiliate this country in the eyes of the world.

Among the recipients of the Report are American servicemen and senior citizens who have also been victimized by myths, misconceptions, and impure motivations at the heart of a propaganda campaign waged by the 21st century's totalitarian commissars.

Join me as I make the winning case that we as a nation have become more addicted to the "Opioid Crisis" than we ever were to opioids. For our nation’s leaders, opioids have become an irresistible diversion and scapegoat. In a striking reversal of cause and effect, these leaders would have you blame opioids for existential fallout (e.g., stagnant workforce participation rate) from waves of socioeconomic crises and technological disruption (of which a broader substance use is one of many symptoms).

My wives (current and former), late mother, mother-in-law, and cousin are among the 11-23 million Americans who require serious pain medication at any point in time, many on an ongoing basis due to chronic conditions. The impact to these citizens by punitive policies restricting access to pharmaceuticals they had been prescribed for months or years is utterly destabilizing, affecting not only their quality of life and capacity to function, but that of anyone who depends on them. These forsaken patients, forced to wear an unfortunately named NARX Score (talk about your N words) that would bring a blushing grins to the face of Hester Prynne and millions of Jews, gypsies, and homosexuals living in Germany during the 1940s, feel as though they have been subjected to demonization, dehumanization, and deindividuation. They were vulnerable to begin with, many suffering clinical anxiety or depression related to pain -- and now they have to figure out how to make do with less and how this will impact relationships with loved ones who have to assume a greater share of the household responsibilities. When I was growing up, I imagined natural disasters -- terrorism -- even World War 3 -- but never a world in which our Government would drive incendiary wedges between doctors, patients, and pharmacists and treat pharmaceutical companies like international cartels, physicians as dealers, and patients as addicts. I have even eavesdropped on a conversation in which a doctor was urged by his wife -- who helped out in the office -- not to risk losing his license to treat a few troublesome patients the DEA admonished him to abandon. "You still have two kids in college and med school loans."

How dare the Government storm our bedrooms like this? We never tolerated this on the issue of abortion.

All these patients want is for a leader to restore what was taken from them: the Constitutional right to pursue a life free from pain; the right to a private relationship with a doctor (unfettered by the DEA using the Prescription Drug Monitoring Database as a surveillance tool); a physician’s right to exercise clinical judgements based on training, intimate knowledge of the patient, and something called the Hippocratic Oath; and their physician’s right to due process before and after their careers were destroyed by a DEA raid on their offices. There is also the consumer's right to pursue products or services known to make a difference in his or her quality of life (free market), and the citizens right to expect policies based on scholarly motives and a science free from bias and conflict (objectivity).

Our compassionate care system was once the hallmark of American superiority and the cornerstone of a civilization. It was the kind of thing that made us proud not to be Soviets.

Imagine what you could accomplish, especially in a state rich with aging Americans, if you committed to turning this around. Hard to believe we once rallied around Joe McCarthy (R-WI) and his House on un-American Activities, thinking it was noble, necessary, and even patriotic to destroy the lives and livelihoods of American citizens suspected of harboring Communist sympathies or of harboring the names of those suspected of harboring Communist sympathies. Once we came to our collective senses, we were embarrassed to say the least. The same applied to the trials in Salem, MA and Manhattan Beach, CA (McMartin School) and to Prohibition. And I believe it will apply here too ... to what we're doing to anyone connected to the supply of legally manufactured pain medication. Our Government has blood on its hands as it drives abandoned patients to suicide or to the Street. You can get ahead of this thing.

The CDC violated Federal law by hiring so many biased contributors -- representing an extremist group at the fringe of the medical community (i.e., PROP) -- with undisclosed conflicts -- to create the 2016 Opioid Prescribing Guidelines in abject secrecy. We appreciate the AMA's 17-page June 16, 2020 protest letter to the CDC. But if this is the only recourse, the AMA looks as foolish pleading with PROP as the U.S. Army did asking Poncho Villa's 3-man guerilla cavalry to stop decimating our supply chains and killing innocent civilians. The AMA cannot shrink from calling PROP a fringe, extremist group that used personal relationships with Tom Frieden to hijack the CDC. A record number of Americans have lost faith in the CDC at the worst imaginable time of a pandemic -- not because of how mask mandates were politicized -- but because the CDC's Center for Injury Prevention and Control embraced an arbitrary threshold whose mean-spiritedness is matched only by its utter lack of scientific and clinical support. There's no denying the word "absurd" as it pops into my head in response to the total disregard for individual differences in diagnosis, treatment history (tolerance), and enzyme-mediated sensitivity to pain and to pain medication. There is simply no basis in science or nature for a one-size-fits-all limit on "equivalent morphine units" (whatever that means). HumanRightsWatch charged the CDC with crimes against humanity over these Guidelines. Is the AMA going to stand for this? Is the AMA going to watch thousands of its members as they are harassed, threatened, suspended, or prosecuted for violating these arbitrary and politically motivated thresholds?

I put the attached Report together as an expert in collective behavior / group psychology (PhD, Social Psychology, 1997), Federal governance (HHS/ASPR; DOD/DHA/BUMED; & DOL/ETA), knowledge production, and pain management. I also have 23 years worth of familial ties to chronic pain patients, including two wives, a mother with terminal cancer, a mother-in-law, and cousin.

The Report was inspired by a family -- MY family -- and so it will go out to families and physicians across the country with the aid of patient-advocate-led communities 300 strong I mobilized on two social media platforms. Still -- it hardly seems like a fair fight. The meek of the Earth versus an army of Federally funded hardy Type A personalities falling over one another and burning the midnight oil figuring how to advance their careers by making life harder for people to treat their chronic pain.

You may decide against reading what I have sent you, but you will likely hear about it from your peers, co-workers, or constituents in the months to come. It is making the rounds. Legislatures. Medical boards. Medical associations. Patient advocacy groups. Defense attorneys (I was twice asked to serve as an expert witness by physician counsel). Federal agencies. In the past 48 hours my associates have disseminated this Report to the parties listed after my signature below (excluding media).


All the best,



Matthew Giarmo, Ph.D.
Senior Analyst
703.608.4843


All members of the following groups:

CDC Opioid Work Group
United States House Reform and Oversight Committee
AMA Board of Trustees & Professional Staff
AARP Board of Directors
California Legislature (Assembly & Senate)
Colorado Legislature (Assembly & Senate)
Connecticut Legislature (Assembly & Senate)
Florida Legislature (Assembly & Senate)
Georgia Legislature (Assembly & Senate)
Indiana Legislature (Assembly & Senate)
Louisiana Legislature (Assembly & Senate)
Maryland Legislature (Assembly & Senate)
Massachusetts Legislature (Assembly & Senate)
Michigan Legislature (Assembly & Senate)
Nevada Legislature (Assembly & Senate)
New York Legislature (Assembly & Senate)
New Jersey Legislature (Assembly & Senate)
Ohio Legislature (Assembly & Senate)
Pennsylvania Legislature (Assembly & Senate)
South Carolina Legislature (Assembly & Senate)
Texas Legislature (Assembly & Senate)
Utah Legislature (Assembly & Senate)
Vermont Legislature (Assembly & Senate)
Virginia Legislature (Assembly & Senate)
Washington Legislature (Assembly & Senate)
West Virginia Legislature (Assembly & Senate)
Wisconsin Legislature (Assembly & Senate)
California State Medical Board
New York State Joint Senate Task Force on Opioids, Addiction, and Overdose Prevention
Oregon House Health Committee
Oregon Senate Health Committee
Oregon Health Authority (administrative & professional staff)
CDC Director Walensky
White House ONDCP Director
Debra Houry, Director, CDC Center for Injury Prevention and Control

DaVinci95  
#2 Posted : Thursday, August 5, 2021 5:33:24 AM(UTC)
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Appreciate your passion, but this letter is not going to encourage anyone but tin-foil-hat-wearing conspiracy nuts to read your report. If you want anyone reputable to take you seriously, drop the references to Nazis, McCarthyism, abortion, Salem witch trials, etc., etc.
tic32003  
#3 Posted : Thursday, August 5, 2021 9:26:54 AM(UTC)
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Sounds like some doctor, somewhere made the right call in cutting off someone's prescription opioids and that someone ain't happy about it.

Opioid addiction IS real and it IS a problem.

Not to minimize anyone's pain, but someone needs to work really hard to get that big ol' addiction gorilla off his or her back.
Federal_Betrayal  
#4 Posted : Thursday, August 5, 2021 4:47:54 PM(UTC)

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It is a real problem for an estimated 6% of chronic pain patients prescribed opioids, 0.7% of acute pain patients, and a fraction (4 in 11,000) postsurgical patients. Not to minimize the plight of these individuals because after all, 6% of 11 - 23 million is a lot of people, but we can't ignore the 94% for whom dependency does not occur (because for many of these individuals, opioids remain the most effective if not only effective means to restore some capacity to function and quality of life.

Discrimination against this clinical minority is just as real if not more real than the construct we call addiction. Cavalier and uninformed references to "addicts" is a lazy way of avoiding the need to evaluate on a case by case basis. Servicemen are among those who suffer involuntary discontinuation of medication and, to add insult to injury, social discrimination.
Federal_Betrayal  
#5 Posted : Thursday, August 5, 2021 5:07:58 PM(UTC)

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I understand your position regarding the references to Nazis, but I believe the comparison I made was to "Germany in the 1940s." This is no cavalier / facile / "drive-by" reference; it's a reasoned isolation of tactics that bear remarkably compelling similarities. Perhaps Holocaust deniers might recommend repressing that kind of sociological analysis. You're not a denier, are you?

I hear all too often from cops and grieving survivors of dead heroin addicts, "have you ever embraced someone dying of a heroin overdose?" Okay. But have you ever embraced someone living with untreated pain from a neurological disorder? There are millions more who are currently enduring and who will at some point endure that kind of suffering. And unlike the heroin addict, they bare absolutely no responsibility for their condition.

Anyway, it's not a competition. The Fed is pitting the needs of these two populations against one another unnecessarily. We can treat those in need of rehabilitation without having to put millions of others through pain, the scale of which will even leave a mark on our nation’s productivity and workforce participation. We don't have an opioid crisis nearly as bad as an untreated pain crisis.

DaVinci95  
#6 Posted : Friday, August 6, 2021 4:10:06 AM(UTC)
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It’s irrelevant hyperbole that undermines the integrity of your argument.
Federal_Betrayal  
#7 Posted : Friday, August 6, 2021 4:38:21 AM(UTC)

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Ordinarily I'd agree. I mean what you're saying makes a lot of sense. I've considered this. But I realized that all the right people were protesting so loudly that I might just be doing something right. I re-read my material and realized the references, when mixed in with enough data and embedded in a dispassionate high level sociological analysis, actually augments rather than undermines the argument. The imagery -- all quite appropriate -- supports the logic and the numbers. Can you believe the Fed is using the Prescription Drug Monitoring Database to spy on your office visits and prescriptions? Can you believe they are assigning everyone to one of 9 groups based on the morphine, sedatives, or stimulants they were prescribed over the past 2 years (adjusted by number prescribers and pharmacies)? Can you believe they are calling this 3 digit number a NARX Score? Talk about your N words. A bit on the nose, isn't it? I mean, who is the true purveyor of hyperbole here? You see some of the anti-opioid TV ads? Now THAT is not only hyperbole. It crosses over into falsehood. The NARX Score is a means of creating a dehumanizing and deindividuating remoteness from those you want to subsequently harm. Social psychologists have subjected this tactic to a great deal of study, and these social scientists cite what happened in World War 2 Germany as the inspiration and the archetypal illustration. If it's good enough for them, it's good enough for me. Especially considering I'm one of them.

Statisticians. Actuatial scientists. Underwriters. They never did make good civil rights leaders. No one ever lines up behind them.
tic32003  
#8 Posted : Friday, August 6, 2021 5:29:27 AM(UTC)
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Originally Posted by: Federal_Betrayal Go to Quoted Post


Discrimination against this clinical minority is just as real if not more real than the construct we call addiction. Cavalier and uninformed references to "addicts" is a lazy way of avoiding the need to evaluate on a case by case basis. Servicemen are among those who suffer involuntary discontinuation of medication and, to add insult to injury, social discrimination.


And throwing the term "discrimination" around where no such thing exists smells of desperation.

Edited by user Friday, August 6, 2021 5:31:32 AM(UTC)  | Reason: Not specified

DaVinci95  
#9 Posted : Friday, August 6, 2021 11:57:29 AM(UTC)
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You do you, but when you start comparing a prescription tracking system to Nazis and racists you’ve lost me. I have no interest in reading a “report” by someone who comes across as a conspiracy nut.
Federal_Betrayal  
#10 Posted : Friday, August 6, 2021 9:36:36 PM(UTC)

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Who are the real drama queens here? You boys wouldn't happen to work as censors for the FCC? You don't like words like Nazi, conspiracy, or discrimination. Incidentally I did not use the terms Nazi or conspiracy, so you may want to get that checked out.

You prefer I confine my speech to numbers. Data only. Or I could talk in 1s and 0s and we can make it a less formal thing. I have some numbers for you. The Journal of the American Medical Association reported a retrospective cohort study of 113,000 persons on long term (> 12 months) high dose (> 50 milligram morphine equivalent units) opioid therapy. They found that the rate of overdose was 68% higher among those subjected to forced tapering than among those who were not so subjected. They also found the rate of mental health crisis 128% greater among those subjected to forced tapering, including a 430% higher incidence of suicide. In other words, the data suggest that the Fed has blood on its hands. Or am I being dramatic?


Discrimination has been well established. Clearly you are naive in the ways of the world. Once abandoned by their former doctors, chronic pain patients are being turned away as new patients on the grounds they had been receiving scripts for opiates. This is a common practice. The Office of Civil Rights has had to intervene in some cases to negotiate a change in what is being regarded as discriminatory policy on the part of many medical practices.

Perhaps you'd prefer the term "adverse impact" to "discrimination." This is a technical term preferred by social scientists. But what do the terms even matter when policies executed in plain sight separate patients from medications they had been receiving every month for 5 - 10 years? In this heightened regulatory environment (AKA police state, or am I being dramatic?), doctors are pressured to withhold medication against their clinical judgement. The patients who had relied on these medications to function find they are no longer able to meet household or employment-related responsibilities. Some suddenly meet the SSA stringent quantifiable criteria for medical disability where they did not previously under opioid therapy.

And employers are lobbying for the right to know whether job candidates are being prescribed an opioid. At present, if the candidate can provide the lab with evidence for a valid script from a doctor, the opioid finding is simply reported as "negative." Many employers have already persuaded the carriers of their employee health insurance to deny coverage for opioids.

And since Government propaganda began depicting pharmaceutical houses as international cartels, doctors as dealers, and patients as addicts, chronic pain patients are reporting that they are being treated as criminals or morally inferior personalities by friends and family.

I'll call that discrimination. Or I am being dramatic?

The craziness that was Prohibition lasted roughly a decade as did the McCarthy-led response to the Red Scare. Eventually once the mass hysteria that is the "Opioid Crisis" has run its course, you will be looking at a civil rights movement for the chronic pain patient community under the auspices of the ADA. There is a section of the Act that explicitly addresses pain medication policy and provides protection to patients from the CDC and the States (with an exemption only for the FDA).

Edited by user Friday, August 6, 2021 10:18:09 PM(UTC)  | Reason: Not specified

Federal_Betrayal  
#11 Posted : Friday, August 6, 2021 9:54:57 PM(UTC)

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But there is a conspiracy. When CDC officials arrange in secrecy for members of an extremist group operating on the fringes of the medical community (i.e., Physicians for Responsible Opioid Prescribing) to staff the preponderance of the Core Expert Group ... when the CDC agrees to hide the identities and subsequently the conflicts of interest of these PROP consultants ... and agrees the meetings will take place behind closed doors so that when the minutes / summaries are FOIA-ed, 80% of the text is redacted ... and when investigative journalists reveal double standards in the inclusion and exclusion of research cited to inform prescribing policy ... I'd say the minimum criteria for conspiratorial activity is observed.

When a woman is raped, do you feel the need to advise her and any news reporter covering the incident to refrain from using the word "rape" because you find it overly dramatic? Do you advise the woman that her complaint will lose all credibility if she claims to have been "raped"?

Now you seem to want to put words in my mouth. Anyone reading your post who did not read mine might be inclined to think I used the word "Nazi" and "conspiracy" when I did not.

Now if I want to refer to events that occurred on German soil during the second World War to fulfill the logical requirements of a sociological analysis, I will do so. You may see the word "Nazi" even where I do not use it. Similarly, if I want to call attention to strategic partnerships that violate Federal laws and scholarly motives in order to enforce a preordained conclusion and political objective, I will do so. You may see the word "conspiracy" even where I do not use it.
old fed  
#12 Posted : Monday, August 16, 2021 2:26:34 PM(UTC)
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Originally Posted by: Federal_Betrayal Go to Quoted Post
But there is a conspiracy. When CDC officials arrange in secrecy for members of an extremist group operating on the fringes of the medical community (i.e., Physicians for Responsible Opioid Prescribing) to staff the preponderance of the Core Expert Group ... when the CDC agrees to hide the identities and subsequently the conflicts of interest of these PROP consultants ... and agrees the meetings will take place behind closed doors so that when the minutes / summaries are FOIA-ed, 80% of the text is redacted ... and when investigative journalists reveal double standards in the inclusion and exclusion of research cited to inform prescribing policy ... I'd say the minimum criteria for conspiratorial activity is observed.

When a woman is raped, do you feel the need to advise her and any news reporter covering the incident to refrain from using the word "rape" because you find it overly dramatic? Do you advise the woman that her complaint will lose all credibility if she claims to have been "raped"?

Now you seem to want to put words in my mouth. Anyone reading your post who did not read mine might be inclined to think I used the word "Nazi" and "conspiracy" when I did not.

Now if I want to refer to events that occurred on German soil during the second World War to fulfill the logical requirements of a sociological analysis, I will do so. You may see the word "Nazi" even where I do not use it. Similarly, if I want to call attention to strategic partnerships that violate Federal laws and scholarly motives in order to enforce a preordained conclusion and political objective, I will do so. You may see the word "conspiracy" even where I do not use it.


you know who else hides identities? these groups listed in this story. who are they hiding? well, look there, it's the mfgs.

https://www.statnews.com...s-prescribing-guideline/
Federal_Betrayal  
#13 Posted : Wednesday, September 15, 2021 9:43:47 AM(UTC)

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They SHOULD oppose it. Even the CDC has opposed it. The CDC recently issued a long overdue statement acknowledging that the arbitrary 90 MME threshold in the Guidelines were never intended to serve as a hard limit that should be indiscriminately applied across all patients regardless of differences in diagnosis, treatment history (tolerance), and enzyme-mediated (genetic) sensitivity to pain and to pain medication. But that’s how the DEA and State Medical Boards are enforcing it contrary to every medical group.

I mean, it's obvious. There is no basis in science or nature to determine how much is too much. This is determined on a case by case basis. To do otherwise is to violate the precepts of compassionate and individualized care that is synonymous with medicine itself.

A verdict was handed down in the first lawsuit resolved. The doctor claimed he was doing what the DEA demanded when the DEA claimed his prescription was out of step with CDC Guidelines. And yet the jury awarded $7 million to the family of a man who committed suicide after his monthly allowance was cut 55%.

The FDA called the same people later hired as architects of the CDC Guidelines "crazies" and "extremists" when they were approached by them a few years earlier. If you Google these people and read some of their statements, I think you'd be embarrassed for treating me as the kook and supporting them.
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